Restless Legs Syndrome
An urge to move the legs, worse at rest and at night
Quick Facts
- Type: Neurological sleep-related disorder
- Hallmark: Urge to move the legs with uncomfortable sensations
- Timing: Worse in the evening and at rest
- Common link: Low iron stores in the body
Overview
Restless legs syndrome (RLS), also called Willis-Ekbom disease, is a common condition of the nervous system that creates an overwhelming urge to move the legs. The urge is usually accompanied by uncomfortable sensations deep in the legs, and it is partly or fully relieved by moving.
The symptoms typically appear or worsen in the evening and at night and when sitting or lying still, which makes it hard to relax or fall asleep. As a result, RLS often disrupts sleep and can lead to daytime tiredness. It ranges from mild and occasional to severe and nightly. Many cases are linked to low iron stores or occur during pregnancy, and a range of self-care measures and, when needed, medications can bring relief.
Symptoms
The defining symptom is an urge to move the legs, usually with unpleasant sensations that are hard to describe.
- An irresistible urge to move the legs, often with crawling, tugging, aching, throbbing, or "creepy-crawly" feelings
- Sensations that begin or worsen during rest and inactivity
- Relief, at least partly, with movement such as walking or stretching
- Symptoms that are worse in the evening and at night
- Difficulty falling or staying asleep, and daytime tiredness
- Twitching or jerking of the legs during sleep in many people
The sensations are usually in both legs but can affect the arms, and they are uncomfortable rather than painful in most people.
Causes
In many cases the exact cause is unknown, and the condition is thought to involve the brain chemical dopamine, which helps control muscle movement. Iron, which the brain needs to use dopamine properly, plays an important role, so low iron stores are a key contributor.
- Iron deficiency: Low body iron, even without anemia, is one of the most important and treatable causes.
- Genetics: RLS often runs in families, especially when it starts at a younger age.
- Pregnancy: Symptoms commonly appear in late pregnancy and usually improve after delivery.
- Other conditions: Kidney failure, diabetes, peripheral neuropathy, and Parkinson disease are associated with RLS.
- Medications and substances: Some antidepressants, antihistamines, and anti-nausea drugs, as well as caffeine, alcohol, and nicotine, can worsen symptoms.
Risk Factors
- A family history of restless legs syndrome
- Iron deficiency, with or without anemia
- Pregnancy, especially the last trimester
- Chronic kidney disease and dialysis
- Peripheral neuropathy and diabetes
- Use of certain medications that can aggravate symptoms
- Caffeine, alcohol, and nicotine
Diagnosis
RLS is diagnosed mainly from the symptoms, since there is no single test that confirms it.
- Clinical criteria: The urge to move the legs with uncomfortable sensations, worse at rest and in the evening, and relieved by movement.
- Blood tests: Checking iron stores (ferritin) and looking for related conditions such as kidney problems or diabetes.
- Review of medications: To identify drugs that may be triggering or worsening symptoms.
- Sleep study: Occasionally used when sleep is badly disrupted or another sleep disorder is suspected.
Treatment
Treatment depends on severity and any underlying cause. Mild cases often improve with lifestyle measures, while frequent or severe symptoms may need medication.
- Treating iron deficiency: Iron supplements, when stores are low, can significantly improve or even resolve symptoms; these should be taken under medical guidance.
- Lifestyle measures: Regular moderate exercise, good sleep habits, leg stretching, warm baths, and massage.
- Reducing triggers: Cutting back on caffeine, alcohol, and nicotine, and reviewing medications that worsen RLS.
- Medications: For persistent symptoms, doctors may prescribe certain drugs that affect calcium channels or dopamine, or other agents, chosen carefully because some can cause symptoms to worsen over time.
Self-Care and Prevention
- Keep a regular sleep schedule and a relaxing bedtime routine
- Get regular, moderate exercise, but avoid intense activity late in the day
- Limit caffeine, alcohol, and nicotine, especially in the evening
- Try warm baths, leg massage, stretching, or heat or cold packs
- Have iron levels checked if symptoms are frequent
- Keep busy with activities during periods of unavoidable sitting
When to See a Doctor
See a doctor if leg discomfort and the urge to move are disturbing your sleep, affecting your daytime function or mood, or not improving with self-care. Tell your doctor about any medications you take, as some can trigger or worsen RLS, and ask to have your iron levels checked because correcting low iron can greatly improve symptoms. New or rapidly worsening symptoms, or symptoms with weakness or numbness, should be evaluated to rule out other nerve or circulation problems.
Frequently Asked Questions
What does restless legs syndrome feel like?
Most people describe an irresistible urge to move the legs along with uncomfortable crawling, tugging, aching, or creepy-crawly sensations deep in the legs. The feelings come on at rest, are worse in the evening, and ease when you move, walk, or stretch.
Is restless legs syndrome related to iron?
Yes. Low iron stores in the body, even without anemia, are one of the most important and treatable causes of RLS, because the brain needs iron to use dopamine properly. Checking and correcting iron levels can significantly improve symptoms for many people.
Why is RLS worse at night?
RLS symptoms follow a daily rhythm and naturally worsen in the evening and at night, which is also when people are resting and lying still. This combination of timing and inactivity is why it so often interferes with falling asleep.
Can pregnancy cause restless legs?
Yes. RLS commonly appears or worsens in the last trimester of pregnancy and usually improves or resolves after delivery. Because some treatments are not suitable in pregnancy, it is best managed with a doctor, often focusing on iron status and self-care measures.
What can I do to relieve restless legs at home?
Helpful measures include regular moderate exercise, a consistent sleep routine, warm baths, leg massage and stretching, and cutting back on caffeine, alcohol, and nicotine. If symptoms persist, see a doctor to check iron levels and review any medications that might be making it worse.
References
- National Institute of Neurological Disorders and Stroke (NINDS). Restless Legs Syndrome.
- Mayo Clinic. Restless legs syndrome — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Restless legs syndrome.
- National Heart, Lung, and Blood Institute (NHLBI). Restless Legs Syndrome.